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10/05/2016

From Aids to opioids - how to combat an epidemic

New England Journal of Medicine

The United States is facing a vast epidemic of opioid-related deaths. More than 2.4 million Americans have a severe opioid-use disorder (OUD) involving dependence on pain medications, heroin, or both, and rates of drug-overdose deaths in this country have outpaced mortality from motor vehicle accidents since 2013. The rising death toll has been rivaled in modern history only by that at the peak of the AIDS epidemic in the early 1990s. Although these epidemics differ in nature, the large-scale, highly coordinated response to AIDS that was eventually mounted may be instructive for combating the opioid epidemic.

In the face of growing alarm in communities nationwide, the U.S. Senate recently passed the Comprehensive Addiction and Recovery Act (CARA), which takes incremental steps to combat the epidemic. President Barack Obama signed it into law in July, despite the fact that Congress withheld funding. In his 2017 budget proposal, Obama had incorporated $1.1 billion for expanding access to evidence-based care, including medication-assisted treatment (MAT) using methadone, buprenorphine, or injectable naltrexone. Funding would be targeted to hardest-hit states and those proposing the most promising interventions for getting needed treatment to people with OUD.